1
|
Xiao Y, Cai G, Feng X, Li Y, Guo W, Guo Q, Huang Y, Su T, Li C, Luo X, Zheng Y, Yang M. Splicing factor YBX1 regulates bone marrow stromal cell fate during aging. EMBO J 2023; 42:e111762. [PMID: 36943004 PMCID: PMC10152142 DOI: 10.15252/embj.2022111762] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
Senescence and altered differentiation potential of bone marrow stromal cells (BMSCs) lead to age-related bone loss. As an important posttranscriptional regulatory pathway, alternative splicing (AS) regulates the diversity of gene expression and has been linked to induction of cellular senescence. However, the role of splicing factors in BMSCs during aging remains poorly defined. Herein, we found that the expression of the splicing factor Y-box binding protein 1 (YBX1) in BMSCs decreased with aging in mice and humans. YBX1 deficiency resulted in mis-splicing in genes linked to BMSC osteogenic differentiation and senescence, such as Fn1, Nrp2, Sirt2, Sp7, and Spp1, thus contributing to BMSC senescence and differentiation shift during aging. Deletion of Ybx1 in BMSCs accelerated bone loss in mice, while its overexpression stimulated bone formation. Finally, we identified a small compound, sciadopitysin, which attenuated the degradation of YBX1 and bone loss in old mice. Our study demonstrated that YBX1 governs cell fate of BMSCs via fine control of RNA splicing and provides a potential therapeutic target for age-related osteoporosis.
Collapse
Affiliation(s)
- Ye Xiao
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Guang‐Ping Cai
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Xu Feng
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Yu‐Jue Li
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Wan‐Hui Guo
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Qi Guo
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Yan Huang
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Tian Su
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Chang‐Jun Li
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
| | - Xiang‐Hang Luo
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalChangshaChina
| | - Yong‐Jun Zheng
- Department of Burn SurgeryThe First Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Mi Yang
- Department of Endocrinology, Endocrinology Research CenterXiangya Hospital of Central South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalChangshaChina
| |
Collapse
|
2
|
Use of Eggshells as Bone Grafts around Commercially Pure Titanium Implant Screws Coated with Nano Calcium Sulfate. Int J Biomater 2022; 2022:8722283. [PMID: 35992052 PMCID: PMC9385332 DOI: 10.1155/2022/8722283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/17/2022] [Accepted: 07/08/2022] [Indexed: 01/02/2023] Open
Abstract
Background. Implant insertion in regions with poor bone quantity, such as the posterior maxilla, is potentially associated with an increased rate of implant failure. Calcium sulfate can be used as the coating material for commercially pure titanium (CpTi) and as the bone graft material around implants when bound to eggshell powder to enhance the bone quality and quantity of bone defect regions. This study performed a torque removal test to evaluate the effectiveness of eggshell powder as a bone substitute for filling bone defects around CpTi-coated implants coated with nanocrystalline calcium sulfate. Materials and Methods. Eighty screw implant designs were used in the tibiae of 20 white New Zealand rabbits. A total of uncoated 20 screws constituted the control group, and the remaining 60 screws coated with nano calcium sulfate nanoparticles were used as the experimental groups as follows: 20 screws coated with nano calcium sulfate were used alone in the tibiae without gaps around them, 20 screws coated with nano calcium sulfate were used with the gaps made around them and filled with eggshell powder as the bone graft material, and 20 screws coated with nano calcium sulfate were used with the gaps made around them left unfilled. Results. After 2 to 6 weeks of healing, a significant improvement in bone regeneration and an increase in torque removal values were observed when the bone defect around the CpTi implant coated with nano calcium sulfate was filled with eggshell powder as the bone substitute. Conclusions. Nano calcium sulfate particles applied through the dip-coating method can successfully work as the coating material of CpTi implants. These particles work in synergy with eggshell powder to act as the bone graft around the implants.
Collapse
|
3
|
Hou YC, Zheng CM, Chiu HW, Liu WC, Lu KC, Lu CL. Role of Calcimimetics in Treating Bone and Mineral Disorders Related to Chronic Kidney Disease. Pharmaceuticals (Basel) 2022; 15:952. [PMID: 36015101 PMCID: PMC9415417 DOI: 10.3390/ph15080952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 12/17/2022] Open
Abstract
Renal osteodystrophy is common in patients with chronic kidney disease and end-stage renal disease and leads to the risks of fracture and extraosseous vascular calcification. Secondary hyperparathyroidism (SHPT) is characterized by a compensatory increase in parathyroid hormone (PTH) secretion in response to decreased renal phosphate excretion, resulting in potentiating bone resorption and decreased bone quantity and quality. Calcium-sensing receptors (CaSRs) are group C G-proteins and negatively regulate the parathyroid glands through (1) increasing CaSR insertion within the plasma membrane, (2) increasing 1,25-dihydroxy vitamin D3 within the kidney and parathyroid glands, (3) inhibiting fibroblast growth factor 23 (FGF23) in osteocytes, and (4) attenuating intestinal calcium absorption through Transient Receptor Potential Vanilloid subfamily member 6 (TRPV6). Calcimimetics (CaMs) decrease PTH concentrations without elevating the serum calcium levels or extraosseous calcification through direct interaction with cell membrane CaSRs. CaMs reduce osteoclast activity by reducing stress-induced oxidative autophagy and improving Wnt-10b release, which promotes the growth of osteoblasts and subsequent mineralization. CaMs also directly promote osteoblast proliferation and survival. Consequently, bone quality may improve due to decreased bone resorption and improved bone formation. CaMs modulate cardiovascular fibrosis, calcification, and renal fibrosis through different mechanisms. Therefore, CaMs assist in treating SHPT. This narrative review focuses on the role of CaMs in renal osteodystrophy, including their mechanisms and clinical efficacy.
Collapse
Affiliation(s)
- Yi-Chou Hou
- Division of Nephrology, Department of Medicine, Cardinal-Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan;
| | - Cai-Mei Zheng
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 11031, Taiwan;
- TMU Research Centre of Urology and Kidney, Taipei Medical University, New Taipei City 11031, Taiwan;
| | - Hui-Wen Chiu
- TMU Research Centre of Urology and Kidney, Taipei Medical University, New Taipei City 11031, Taiwan;
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, New Taipei City 11031, Taiwan
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 11031, Taiwan
| | - Wen-Chih Liu
- Department of Biology and Anatomy, National Defense Medical Center, Taipei 11490, Taiwan;
- Section of Nephrology, Department of Medicine, Antai Medical Care Corporation, Anti Tian-Sheng Memorial Hospital, Pingtung 92842, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Buddhist Tzu Chi University, Hualien 97004, Taiwan
- Division of Nephrology, Department of Medicine, Fu-Jen Catholic University Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan;
| | - Chien-Lin Lu
- Division of Nephrology, Department of Medicine, Fu-Jen Catholic University Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan;
| |
Collapse
|
4
|
Rony L, Aguado E, Verlee B, Pascaretti-Grizon F, Chappard D. Osseointegration of two types of titanium cylinders with geometric or trabecular microarchitecture: A nanotomographic and histomorphometric study. Morphologie 2022; 106:80-91. [PMID: 33812797 DOI: 10.1016/j.morpho.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
Porous biomaterials promote osseointegration. We have prepared porous titanium cylinders by additive manufacturing from titanium beads. Two types of morphology were tested: cylinders with geometric pores or mimicking trabecular microarchitecture. Cylinders were decontaminated and cleaned by HF/HNO3 to remove unmelted balls. Surgical implantation in ewes was performed under general anesthesia and the animals were housed for 90 and 270days. The femoral condyles were collected and analyzed by nanoCT, embedded in pMMA and analyzed by histomorphometry. No significant difference was found in terms of bone volume or bone/titanium interface between the two types of cylinders. There was no evolution over time except for the mineralization rates which decreased, reflecting the effect of the aging of the animals. The influence of the pores (geometrical or "natural") did not influence osseointegration. HF/HNO3 etching treatments are effective on the outermost surfaces but do not seem to reach the central cavities of the samples. Finally, osseointegration seems to occur only in the few millimeters around the periphery of the implants and does not extend in the center. This is explained by the absence of stress transmission within the very rigid metal cylinders, preventing bone modeling and remodeling.
Collapse
Affiliation(s)
- L Rony
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - E Aguado
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France; ONIRIS, Ecole Vétérinaire de Nantes, 44307 Nantes Cedex 3, France
| | - B Verlee
- SIRRIS Liège Science Park, Rue du bois St Jean 12, 4102 Seraing, Belgium
| | - F Pascaretti-Grizon
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - D Chappard
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France; SCIAM, Service Commun d'Imagerie et Analyses Microscopiques, IRIS-IBS Institut de Biologie en Santé, Univ-Angers, 49933 Angers Cedex, France.
| |
Collapse
|
5
|
Yan Z, Wang G, Shi X. Advances in the Progression and Prognosis Biomarkers of Chronic Kidney Disease. Front Pharmacol 2022; 12:785375. [PMID: 34992536 PMCID: PMC8724575 DOI: 10.3389/fphar.2021.785375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022] Open
Abstract
Chronic kidney disease (CKD) is one of the increasingly serious public health concerns worldwide; the global burden of CKD is increasingly due to high morbidity and mortality. At present, there are three key problems in the clinical treatment and management of CKD. First, the current diagnostic indicators, such as proteinuria and serum creatinine, are greatly interfered by the physiological conditions of patients, and the changes in the indicator level are not synchronized with renal damage. Second, the established diagnosis of suspected CKD still depends on biopsy, which is not suitable for contraindication patients, is also traumatic, and is not sensitive to early progression. Finally, the prognosis of CKD is affected by many factors; hence, it is ineviatble to develop effective biomarkers to predict CKD prognosis and improve the prognosis through early intervention. Accurate progression monitoring and prognosis improvement of CKD are extremely significant for improving the clinical treatment and management of CKD and reducing the social burden. Therefore, biomarkers reported in recent years, which could play important roles in accurate progression monitoring and prognosis improvement of CKD, were concluded and highlighted in this review article that aims to provide a reference for both the construction of CKD precision therapy system and the pharmaceutical research and development.
Collapse
Affiliation(s)
- Zhonghong Yan
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Guanran Wang
- Heilongjiang University of Chinese Medicine, Harbin, China.,Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xingyang Shi
- Heilongjiang University of Chinese Medicine, Harbin, China
| |
Collapse
|
6
|
Aaltonen L, Koivuviita N, Seppänen M, Burton IS, Kröger H, Löyttyniemi E, Metsärinne K. Bone Histomorphometry and 18F-Sodium Fluoride Positron Emission Tomography Imaging: Comparison Between only Bone Turnover-based and Unified TMV-based Classification of Renal Osteodystrophy. Calcif Tissue Int 2021; 109:605-614. [PMID: 34137924 PMCID: PMC8531121 DOI: 10.1007/s00223-021-00874-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/03/2021] [Indexed: 01/13/2023]
Abstract
Bone biopsy is the gold standard for characterization of renal osteodystrophy (ROD). However, the classification of the subtypes of ROD based on histomorphometric parameters is not unambiguous and the range of normal values for turnover differ in different publications. 18F-Sodium Fluoride positron emission tomography (18F-NaF PET) is a dynamic imaging technique that measures turnover. 18F-NaF PET has previously been shown to correlate with histomorphometric parameters. In this cross-sectional study, 26 patients on dialysis underwent a 18F-NaF PET and a bone biopsy. Bone turnover-based classification was assessed using Malluche's historical reference values for normal bone turnover. In unified turnover-mineralization-volume (TMV)-based classification, the whole histopathological picture was evaluated and the range for normal turnover was set accordingly. Fluoride activity was measured in the lumbar spine (L1-L4) and at the anterior iliac crest. On the basis of turnover-based classification of ROD, 12% had high turnover and 61% had low turnover bone disease. On the basis of unified TMV-based classification of ROD, 42% had high turnover/hyperparathyroid bone disease and 23% had low turnover/adynamic bone disease. When using unified TMV-based classification of ROD, 18F-NaF PET had an AUC of 0.86 to discriminate hyperparathyroid bone disease from other types of ROD and an AUC of 0.87, for discriminating adynamic bone disease. There was a disproportion between turnover-based classification and unified TMV-based classification. More research is needed to establish normal range of bone turnover in patients with CKD and to establish the role of PET imaging in ROD.
Collapse
Affiliation(s)
- Louise Aaltonen
- Department of Medicine, Kidney Center, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
| | - Niina Koivuviita
- Department of Medicine, Kidney Center, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Marko Seppänen
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Inari S Burton
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, 20014, Turku, Finland
| | - Kaj Metsärinne
- Department of Medicine, Kidney Center, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| |
Collapse
|
7
|
The Balance between Orthodontic Force and Radiation in the Jawbone: Microstructural, Histological, and Molecular Study in a Rat Model. BIOLOGY 2021; 10:biology10111203. [PMID: 34827196 PMCID: PMC8615105 DOI: 10.3390/biology10111203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary Patients with head and neck cancer are frequently treated by radiation, which results in a lifelong risk of damage (necrosis) to the jawbones. Some of the irradiated young patients at a later time in life may be interested in orthodontic treatment for esthetic or functional purposes. We undertook this study in order to investigate changes that occur in irradiated jawbones when mild orthodontic force is applied in a rat laboratory model. We found that one low dose of radiation had negatively affected the jawbones and that these changes were visible in X-ray images as well as in microscopic slides. The irradiated bones seemed to be denser in the X-rays and had fewer cells that usually regulate normal bone turnover, compared to non-irradiated bones. However, when orthodontic force was applied after radiation, the changes in the irradiated bones were largely, but not completely, reversed in both X-rays and microscopy to the point that bone properties were approaching those of non-irradiated, orthodontically treated, bones. The findings of this study indicate that orthodontic force may have a beneficial effect on the maintenance of jawbone vitality after radiation, but additional studies using different time-lags between radiation and orthodontic force and higher radiation doses are warranted to support these findings. Abstract Irradiation of facial bones is associated with a lifelong risk of osteonecrosis. In a rat model, maxillae were exposed to a single 5 Gy dose of external beam radiation and orthodontic force was applied for 2 weeks on the first maxillary molar; control rats were treated identically without radiation. Tooth movement in irradiated jaws was 30% less than in controls, representing radiation-related damage. Micro-CT, histological, and molecular outcomes of orthodontic tooth movement were studied. Microstructurally, bone parameters (trabecular thickness, bone volume fraction, bone mineral density) were significantly affected by orthodontic force but not by radiation. Histological parameters were influenced only by orthodontic force, especially by an increase in osteoclasts. A molecular study revealed a differential distribution of cells expressing pre-osteoclast markers (RANK+—majority, CD11b+, CD14+—minority), with changes being influenced by orthodontic force (increased CD11b+ and CD14+ cells) and also by radiation (decreased RANK+ cells). The activation status of osteoclasts (TRAP staining) showed an orthodontic-force-related increase, which probably could not fully compensate for the radiation-associated impairment. The overall balance showed that orthodontic force had elicited a substantial microstructural, histological, and functional normalization process in irradiated maxillae but a radiation-induced impact was still conspicuous. Additional studies are needed to validate these findings.
Collapse
|
8
|
Hughes-Austin JM, Dwight KD, Ginsberg C, Tipps A, Salusky IB, Pereira RC, Ix JH. Regional variation in bone turnover at the iliac crest versus the greater trochanter. Bone 2021; 143:115604. [PMID: 32827849 PMCID: PMC7769907 DOI: 10.1016/j.bone.2020.115604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/20/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Iliac crest bone biopsy with histomorphometry is the gold standard for diagnosis of abnormalities in bone turnover, yet fractures more frequently occur at the greater trochanter of the hip. Whether bone turnover is similar at these two anatomic sites within individuals is uncertain. METHODS We collected bone biopsy samples from the ipsilateral iliac crest and greater trochanter in 9 deceased individuals undergoing autopsies at an academic medical center between March-August 2018. We measured 14 static bone histomorphometry parameters including osteoclast number (N.Oc/T.A), eroded surface (ES/BS), trabecular separation (Tb.Sp), osteoclast surface (Oc.S/BS) and osteoid volume (OV/BV) as markers of bone turnover, mineralization, and volume (TMV), and evaluated the correlation of these markers between the iliac crest and greater trochanter. RESULTS Average age at time of death was 58 ± 15 years, 2 were women, and average time from death to autopsy was 2.9 ± 1.8 days. Overall, correlations of the markers of bone turnover across the two sites were poor, ranging from as low as 0 for Tb.Sp (p = 1.0) to as high as 0.583 for Oc.S/BS (p = 0.102). CONCLUSIONS Static histomorphometric measures of bone turnover at the iliac crest may not provide reliable information about turnover at other anatomic sites.
Collapse
Affiliation(s)
- Jan M Hughes-Austin
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA.
| | - Kathryn D Dwight
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Charles Ginsberg
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, La Jolla, CA, USA; Nephrology Section, Veterans Affairs of San Diego, San Diego, CA, USA
| | - Ann Tipps
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | - Isidro B Salusky
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Renata C Pereira
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, La Jolla, CA, USA; Nephrology Section, Veterans Affairs of San Diego, San Diego, CA, USA
| |
Collapse
|
9
|
Lalayiannis AD, Crabtree NJ, Ferro CJ, Askiti V, Mitsioni A, Biassoni L, Kaur A, Sinha MD, Wheeler DC, Duncan ND, Popoola J, Milford DV, Long J, Leonard MB, Fewtrell M, Shroff R. Routine serum biomarkers, but not dual-energy X-ray absorptiometry, correlate with cortical bone mineral density in children and young adults with chronic kidney disease. Nephrol Dial Transplant 2020; 36:1872-1881. [DOI: 10.1093/ndt/gfaa199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background. Biomarkers and dual-energy X-ray absorptiometry (DXA) are thought to be poor predictors of bone mineral density (BMD). The Kidney Disease: Improving Global Outcomes guidelines suggest using DXA if the results will affect patient management, but this has not been studied in children or young adults in whom bone mineral accretion continues to 30 years of age. We studied the clinical utility of DXA and serum biomarkers against tibial cortical BMD (CortBMD) measured by peripheral quantitative computed tomography, expressed as Z-score CortBMD, which predicts fracture risk.
Methods. This was a cross-sectional multicentre study in 26 patients with CKD4 and 5 and 77 on dialysis.
Results. Significant bone pain that hindered activities of daily living was present in 58%, and 10% had at least one low-trauma fracture. CortBMD and cortical mineral content Z-scores were lower in dialysis compared with CKD patients (P = 0.004 and P = 0.02). DXA BMD hip and lumbar spine Z-scores did not correlate with CortBMD or biomarkers. CortBMD was negatively associated with parathyroid hormone (PTH; r = −0.44, P < 0.0001) and alkaline phosphatase (ALP; r = −0.22, P = 0.03) and positively with calcium (Ca; r = 0.33, P = 0.001). At PTH <3 times upper limit of normal, none of the patients had a CortBMD below −2 SD (odds ratio 95% confidence interval 7.331 to infinity). On multivariable linear regression PTH (β = −0.43 , P < 0.0001), ALP (β = −0.36, P < 0.0001) and Ca (β = 0.21, P = 0.005) together predicted 57% of variability in CortBMD. DXA measures did not improve this model.
Conclusions. Taken together, routinely used biomarkers, PTH, ALP and Ca, but not DXA, are moderate predictors of cortical BMD. DXA is not clinically useful and should not be routinely performed in children and young adults with CKD 4–5D.
Collapse
Affiliation(s)
- Alexander D Lalayiannis
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, London, UK
| | - Nicola J Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Charles J Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Lorenzo Biassoni
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, London, UK
| | - Amrit Kaur
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Manish D Sinha
- Evelina Children’s Hospital, Guy’s & St Thomas' NHS Foundation Trust, London, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Neill D Duncan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Joyce Popoola
- Department of Nephrology and Transplantation, George’s University Hospital NHS Foundation Trust, London, UK
| | - David V Milford
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Jin Long
- Stanford University, Palo Alto, CA, USA
| | | | - Mary Fewtrell
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, London, UK
| | - Rukshana Shroff
- Great Ormond St Hospital for Children NHS Foundation Trust, University College London Institute of Child Health, London, UK
| |
Collapse
|
10
|
Mohamad Asri SF, Soelaiman IN, Mohd Moklas MA, Mohd Nor NH, Mohamad Zainal NH, Mohd Ramli ES. The Role of Piper sarmentosum Aqueous Extract as a Bone Protective Agent, a Histomorphometric Study. Int J Mol Sci 2020; 21:ijms21207715. [PMID: 33086468 PMCID: PMC7589271 DOI: 10.3390/ijms21207715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 01/14/2023] Open
Abstract
Glucocorticoids are one of the causes of secondary osteoporosis. The aqueous extract of Piper sarmentosum contains flavonoids that possess antioxidant effects. In this study, we determined the effects of aqueous Piper sarmentosum leaf extract on structural, dynamic and static histomorphometric changes from osteoporotic bones of rats induced with glucocorticoids. Thirty-two Sprague-Dawley rats were divided equally into four groups—Sham control group given vehicles (intramuscular (IM) olive oil and oral normal saline); AC: Adrenalectomised (Adrx) control group given IM dexamethasone (DEX) (120 μg/kg/day) and vehicle (oral normal saline); AP: Adrx group administered IM DEX (120 μg/kg/day) and aqueous Piper sarmentosum leaf extract (125 mg/kg/day) orally; and AG: Adrx group administered IM DEX (120 μg/kg/day) and oral glycyrrhizic acid (GCA) (120 mg/kg/day). Histomorphometric measurements showed that the bone volume, trabecular thickness, trabecular number, osteoid and osteoblast surfaces, double-labelled trabecular surface, mineralizing surface and bone formation rate of rats given aqueous Piper sarmentosum leaf extract were significantly increased (p < 0.05), whereas the trabecular separation and osteoclast surface were significantly reduced (p < 0.05). This study suggests that aqueous Piper sarmentosum leaf extract was able to prevent bone loss in prolonged glucocorticoid therapy. Thus, Piper sarmentosum has the potential to be used as an alternative medicine against osteoporosis and osteoporotic fractures in patients undergoing long-term glucocorticoid therapy.
Collapse
Affiliation(s)
- Siti Fadziyah Mohamad Asri
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia; (M.A.M.M.); (N.H.M.N.); (N.H.M.Z.)
- Correspondence: (S.F.M.A.); (E.S.M.R.); Tel.: +60-3-9769-2330 (S.F.M.A.); +60-3-9145-8605 (E.S.M.R.)
| | - Ima Nirwana Soelaiman
- Department of Pharmacology, Faculty of Medicines, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Mohamad Aris Mohd Moklas
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia; (M.A.M.M.); (N.H.M.N.); (N.H.M.Z.)
| | - Nurul Huda Mohd Nor
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia; (M.A.M.M.); (N.H.M.N.); (N.H.M.Z.)
| | - Nurul Hayati Mohamad Zainal
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia; (M.A.M.M.); (N.H.M.N.); (N.H.M.Z.)
| | - Elvy Suhana Mohd Ramli
- Department of Anatomy, Faculty of Medicines, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Correspondence: (S.F.M.A.); (E.S.M.R.); Tel.: +60-3-9769-2330 (S.F.M.A.); +60-3-9145-8605 (E.S.M.R.)
| |
Collapse
|
11
|
Aaltonen L, Koivuviita N, Seppänen M, Tong X, Kröger H, Löyttyniemi E, Metsärinne K. Correlation between 18F-Sodium Fluoride positron emission tomography and bone histomorphometry in dialysis patients. Bone 2020; 134:115267. [PMID: 32058018 DOI: 10.1016/j.bone.2020.115267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The diagnosis of renal osteodystrophy is challenging. Bone biopsy is the gold standard, but it is invasive and limited to one site of the skeleton. The ability of biomarkers to estimate the underlying bone pathology is limited. 18F-Sodium Fluoride positron emission tomography (18F-NaF PET) is a noninvasive quantitative imaging technique that allows assessment of regional bone turnover at clinically relevant sites. The hypothesis of this study was, that 18F-NaF PET correlates with bone histomorphometry in dialysis patients and could act as a noninvasive diagnostic tool in this patient group. METHODS This was a cross-sectional diagnostic test study. 26 dialysis patients with biochemical abnormalities indicating mineral and bone disorder were included. All the participants underwent a 18F-NaF PET scan and a bone biopsy. Fluoride activity in the PET scan was measured in the lumbar spine and at the anterior iliac crest. Dynamic and static histomorphometric parameters of the bone biopsy were assessed. As histomorphometric markers for bone turnover we used bone formation rate per bone surface (BFR/BS) and activation frequency per year (Ac.f). RESULTS There was a statistically significant correlation between fluoride activity in the 18F-NaF PET scan and histomorphometric parameters such as bone formation rate, activation frequency and osteoclast and osteoblast surfaces and mineralized surfaces. 18F-NaF PET's sensitivity to recognize low turnover in respect to non-low turnover was 76% and specificity 78%. Because of the small number of patients with high turnover, we were unable to demonstrate significant predictive value in this group. CONCLUSIONS A clear correlation between histomorphometric parameters and fluoride activity in the 18F-NaF PET scan was established. 18F-NaF PET may possibly be a noninvasive diagnostic tool in dialysis patients with low turnover bone disease, but further research is needed.
Collapse
Affiliation(s)
- Louise Aaltonen
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland.
| | - Niina Koivuviita
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20521, Finland
| | - Xiaoyu Tong
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland; Kuopio University Hospital, Kuopio, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, 20014 Turku, Finland
| | - Kaj Metsärinne
- Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland
| |
Collapse
|
12
|
Lalayiannis A, Crabtree N, Fewtrell M, Biassoni L, Milford D, Ferro C, Shroff R. Assessing bone mineralisation in children with chronic kidney disease: what clinical and research tools are available? Pediatr Nephrol 2020; 35:937-957. [PMID: 31240395 PMCID: PMC7184042 DOI: 10.1007/s00467-019-04271-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/11/2022]
Abstract
Mineral and bone disorder in chronic kidney disease (CKD-MBD) is a triad of biochemical imbalances of calcium, phosphate, parathyroid hormone and vitamin D, bone abnormalities and soft tissue calcification. Maintaining optimal bone health in children with CKD is important to prevent long-term complications, such as fractures, to optimise growth and possibly also to prevent extra-osseous calcification, especially vascular calcification. In this review, we discuss normal bone mineralisation, the pathophysiology of dysregulated homeostasis leading to mineralisation defects in CKD and its clinical consequences. Bone mineralisation is best assessed on bone histology and histomorphometry, but given the rarity with which this is performed, we present an overview of the tools available to clinicians to assess bone mineral density, including serum biomarkers and imaging such as dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. We discuss key studies that have used these techniques, their advantages and disadvantages in childhood CKD and their relationship to biomarkers and bone histomorphometry. Finally, we present recommendations from relevant guidelines-Kidney Disease Improving Global Outcomes and the International Society of Clinical Densitometry-on the use of imaging, biomarkers and bone biopsy in assessing bone mineral density. Given low-level evidence from most paediatric studies, bone imaging and histology remain largely research tools, and current clinical management is guided by serum calcium, phosphate, PTH, vitamin D and alkaline phosphatase levels only.
Collapse
Affiliation(s)
- A.D. Lalayiannis
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - N.J. Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - M. Fewtrell
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - L. Biassoni
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| | - D.V. Milford
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - C.J. Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R. Shroff
- Nephrology Department Great Ormond St. Hospital for Children NHS Foundation Trust and University College London Institute of Child Health, London, UK
| |
Collapse
|
13
|
Hung CC, Fu E, Chiu HC, Liang HC. Bone formation following sinus grafting with an alloplastic biphasic calcium phosphate in Lanyu Taiwanese mini-pigs. J Periodontol 2019; 91:93-101. [PMID: 31350789 DOI: 10.1002/jper.17-0748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate the new bone formation after grafting with a synthetic biphasic calcium phosphate in sinuses with minimal bone height, the alloplastic and xenograft materials were compared after grafting into Lanyu Taiwanese mini-pig sinuses via split-mouth design. METHODS In six mini-pigs, synthetic hydroxyapatite/tricalcium phosphate (HA/TCP) particles were inserted into one of the sinus cavities using the extra-oral approach, where deproteinized bovine bone mineral (DBBM) particles were placed contralaterally. Fluorescent bony labels of Alizarin and Calcein green were delivered at weeks 4 and 8, respectively. Animals were sacrificed at week 12 and the augmented tissues were evaluated by cone-beam computed tomography, microcomputed tomography, and histology. RESULTS By radiographic examination, the mean thicknesses of sinus cortexes for DBBM and HA/TCP groups were similar (0.35 versus 0.38 cm) and the mean volumes augmented were also indifferent (1.29 versus 1.64 cm3 ). The distributions of bones, residual particles, and non-mineralized tissues in augmented masses between groups were undistinguishable. Under microscopy, however, macroporosities of osteons were filled with HA/TCP residual particles, whereas the newly formed bones lay on top of DBBM particle surfaces. Although the mineral deposition rates between groups were indifferent, the mean labeled surface in the HA/TCP group was significantly greater than those in the DBBM group at week 4 (35.16% versus 14.00% for HA/TCP and DBBM, respectively) but less than that at week 8 (19.33% versus 39.16%, respectively). CONCLUSION Sinus augmentation with synthetic HA/TCP and DBBM exhibited similar effectiveness in new bone formation.
Collapse
Affiliation(s)
- Chao-Chien Hung
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
| | - Earl Fu
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan.,Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hsien-Chung Chiu
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
| | - Huang-Chien Liang
- Department of Materials Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| |
Collapse
|
14
|
Yang G, Ge Y, Zha X, Mao H, Wang N, Xing C. Peritoneal dialysis can alleviate the clinical course of hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol 2019; 51:535-542. [PMID: 30689179 DOI: 10.1007/s11255-019-02076-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE It is unclear whether clinical courses of hungry bone syndrome (HBS) after parathyroidectomy (PTX) in peritoneal dialysis (PD) and hemodialysis (HD) patients are different. The present study aimed to investigate the possible differences of postoperative hypocalcemia and hyperkalemia between PD and HD patients. METHODS We performed retrospectively 29 PD patients as the PD group and 169 HD patients as the HD group undergoing successful total PTX with autotransplantation. Calcium supplement after surgery was recorded. Higher levels of serum potassium during and immediately after surgery were recorded as K+d0. K+d3 was recorded as peak pre-dialysis serum potassium level 3 days post-surgery. RESULTS There were 157 (92.90%) patients in HD group and 22 (75.86%) patients in PD group suffered from HBS after surgery, with significant difference between the groups (P = 0.004). Patients in PD group had significantly shorter intravenous calcium supplement duration (P = 0.037) and significantly smaller intravenous calcium supplement dosage (P = 0.042) and total calcium supplement dosage during hospitalization (P = 0.012) than patients in HD group. The levels of serum K+d0 (P < 0.001) and K+d3 (P < 0.001) were both significantly lower in PD group than those in HD group. Peritoneal dialysis was one of the independent influencing factors with negative correlation for calcium supplement, serum K+d0 and serum K+d3. CONCLUSIONS Compared with HD patients, the clinical course of HBS after PTX in PD patients was alleviated. Efforts should be devoted to individual perioperative management for PD patients undergoing PTX.
Collapse
Affiliation(s)
- Guang Yang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yifei Ge
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Xiaoming Zha
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Huijuan Mao
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Ningning Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Changying Xing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
| |
Collapse
|
15
|
Barreto FDC, Costa CRVD, Reis LMD, Custódio MR. Bone biopsy in nephrology practice. ACTA ACUST UNITED AC 2018; 40:366-374. [PMID: 30525179 PMCID: PMC6534004 DOI: 10.1590/2175-8239-jbn-2017-0012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
Abstract
Renal osteodystrophy (ROD), a group of metabolic bone diseases secondary to chronic kidney disease (CKD), still represents a great challenge to nephrologists. Its management is tailored by the type of bone lesion - of high or low turnover - that cannot be accurately predicted by serum biomarkers of bone remodeling available in daily clinical practice, mainly parathyroid hormone (PTH) and alkaline phosphatase (AP). In view of this limitation, bone biopsy followed by bone quantitative histomorphometry, the gold-standard method for the diagnosis of ROD, is still considered of paramount importance. Bone biopsy has also been recommended for evaluation of osteoporosis in the CKD setting to help physicians choose the best anti-osteoporotic drug. Importantly, bone biopsy is the sole diagnostic method capable of providing dynamic information on bone metabolism. Trabecular and cortical bones may be analyzed separately by evaluating their structural and dynamic parameters, thickness and porosity, respectively. Deposition of metals, such as aluminum and iron, on bone may also be detected. Despite of these unique characteristics, the interest on bone biopsy has declined over the last years and there are currently few centers around the world specialized on bone histomorphometry. In this review, we will discuss the bone biopsy technique, its indications, and the main information it can provide. The interest on bone biopsy should be renewed and nephrologists should be capacitated to perform it as part of their training during medical residency.
Collapse
Affiliation(s)
| | | | - Luciene Machado Dos Reis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas, Laboratório de Fisiopatologia Renal São Paulo, SP, Brasil
| | - Melani Ribeiro Custódio
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas, Laboratório de Fisiopatologia Renal São Paulo, SP, Brasil
| |
Collapse
|
16
|
Yang G, Zha X, Mao H, Yu X, Wang N, Xing C. Hypocalcemia-based prediction of hungry bone syndrome after parathyroidectomy in hemodialysis patients with refractory secondary hyperparathyroidism. J Int Med Res 2018; 46:4985-4994. [PMID: 30064280 PMCID: PMC6300944 DOI: 10.1177/0300060518788744] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective This study was performed to explore the risk factors for hungry bone syndrome (HBS) and establish prediction equations for calcium supplementation after parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism. Methods We retrospectively analyzed data from 252 hemodialysis patients undergoing successful total parathyroidectomy with autotransplantation. HBS was defined according to a minimum postoperative serum corrected calcium (PcCa) concentration of <2.0 mmol/L. Independent predictors of HBS were analyzed, and prediction equations for HBS were derived accordingly. Results The incidence of HBS was 71.4%. The serum corrected calcium and preoperative serum alkaline phosphatase (ALP) concentrations were independent predictors of HBS. The preoperative serum ALP, intact parathyroid hormone (iPTH), and hemoglobin concentrations were independent factors influencing the average descending velocity of the PcCa concentration before calcium supplementation (PcCa-V), intravenous calcium supplement holding time (IVCa-T), and intravenous calcium supplement dosage (IVCa), while the serum ALP and iPTH concentrations were independent predictors of the oral calcium supplement dosage (OCa). Four prediction equations for PcCa-V, IVCa-T, IVCa, and OCa were established. Conclusions Establishment of prediction equations for HBS may contribute to a new individualized therapy for patients with HBS.
Collapse
Affiliation(s)
- Guang Yang
- 1 Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoming Zha
- 2 Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huijuan Mao
- 1 Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiangbao Yu
- 1 Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ningning Wang
- 1 Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changying Xing
- 1 Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
17
|
Bhattoa HP. Laboratory aspects and clinical utility of bone turnover markers. EJIFCC 2018; 29:117-128. [PMID: 30050395 PMCID: PMC6053812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With an aging population, there is a marked increase in prevalence of metabolic bone diseases, especially osteoporosis. Perhaps the most dreaded complication of metabolic bone disease, fractures typically impose a huge burden on the ailing body and are associated with high co-morbidity and mortality. The consequent public health and socioeconomic burden warrant timely diagnosis, treatment and follow-up of these disorders. Knowing the limitations of radiological techniques, biochemical markers of bone turnover measurements come handy since the changes in their levels readily reflect bone physiology. Bone biomarkers typically analyzed in high throughput automated routine laboratories are collagen degradation products, reflecting osteoclast activity, and the collagenous or non-collagenous proteins produced by the osteoblasts. Since bone biomarker levels vary considerably due to quite a few endogenous and exogenous pre-analytical factors, knowledge of these limitations is mandatory prior to clinical utilization since these variabilities complicate test result interpretation. Standardization to harmonize different assay methodologies is desired, and the primary aims of the IFCC/IOF bone marker standards working group are also presented. Current literature data advocate bone markers as best used in monitoring anti-osteoporosis therapy efficacy and compliance, nonetheless, there is abundant data supporting their role in predicting bone loss and fracture risk. Furthermore, they have widespread clinical utility in osteoporosis, renal osteodystrophy, and certain oncological conditions and rheumatic diseases.
Collapse
Affiliation(s)
- Harjit Pal Bhattoa
- Corresponding author: Harjit Pal Bhattoa Department of Laboratory Medicine Faculty of Medicine University of Debrecen Hungary E-mail:
| |
Collapse
|
18
|
Time to rethink the use of bone biopsy to prevent fractures in patients with chronic kidney disease. Curr Opin Nephrol Hypertens 2018; 27:243-250. [DOI: 10.1097/mnh.0000000000000418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
19
|
Abstract
Chronic kidney disease affects 23 million Americans and is associated with many complications, one of the most complex of which is mineral and bone disorder. Pathophysiologic mechanisms begin to occur early in CKD but when the glomerular filtration rate declines to <50% of normal, biochemical and bone matrix abnormalities, which vary and are multifactorial, begin to be clinically apparent. Mainstays of treatment remain management of hyperphosphatemia and prevention or treatment of secondary hyperparathyroidism.
Collapse
|
20
|
Yeh SCA, Wilk K, Lin CP, Intini G. In Vivo 3D Histomorphometry Quantifies Bone Apposition and Skeletal Progenitor Cell Differentiation. Sci Rep 2018; 8:5580. [PMID: 29615817 PMCID: PMC5882859 DOI: 10.1038/s41598-018-23785-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/20/2018] [Indexed: 01/07/2023] Open
Abstract
Histomorphometry and Micro-CT are commonly used to assess bone remodeling and bone microarchitecture. These approaches typically require separate cohorts of animals to analyze 3D morphological changes and involve time-consuming immunohistochemistry preparation. Intravital Microscopy (IVM) in combination with mouse genetics may represent an attractive option to obtain bone architectural measurements while performing longitudinal monitoring of dynamic cellular processes in vivo. In this study we utilized two-photon, multicolor fluorescence IVM together with a lineage tracing reporter mouse model to image skeletal stem cells (SSCs) in their calvarial suture niche and analyze their differentiation fate after stimulation with an agonist of the canonical Wnt pathway (recombinant Wnt3a). Our in vivo histomorphometry analyses of bone formation, suture volume, and cellular dynamics showed that recombinant Wnt3a induces new bone formation, differentiation and incorporation of SSCs progeny into newly forming bone. IVM technology can therefore provide additional dynamic 3D information to the traditional static 2D histomorphometry.
Collapse
Affiliation(s)
- Shu-Chi A Yeh
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA.,Advanced Microscopy Program, Center for Systems Biology and Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Katarzyna Wilk
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA
| | - Charles P Lin
- Advanced Microscopy Program, Center for Systems Biology and Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. .,Harvard Stem Cell Institute, Cambridge, MA, 02138, USA.
| | - Giuseppe Intini
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA. .,Harvard Stem Cell Institute, Cambridge, MA, 02138, USA.
| |
Collapse
|
21
|
Bartko J, Roschger P, Zandieh S, Brehm A, Zwerina J, Klaushofer K. Hypophosphatemia, Severe Bone Pain, Gait Disturbance, and Fatigue Fractures After Iron Substitution in Inflammatory Bowel Disease: A Case Report. J Bone Miner Res 2018; 33:534-539. [PMID: 29068481 DOI: 10.1002/jbmr.3319] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/02/2017] [Accepted: 10/20/2017] [Indexed: 01/12/2023]
Abstract
Intravenous infusions of different iron formulations are recognized as a cause of hypophosphatemia. Chronic hypophosphatemia can alter bone metabolism and bone material structure. As a consequence, osteomalacia may develop and lead to bone fragility. Herein, we report a patient with Crohn's disease presenting with persistent hypophosphatemia and insufficiency fractures while receiving regular iron infusions due to chronic gastrointestinal bleeding. Previously, the patient regularly received vitamin D and also zoledronic acid. The patient underwent bone biopsy of the iliac crest that showed typical signs of osteomalacia with dramatically increased osteoid volume and decreased bone formation. Analysis of the bone mineralization density distribution (BMDD) revealed a more complex picture: On the one hand, there was a shift to higher matrix mineralization, presumably owing to low bone turnover; on the other hand, a broadening of the BMDD indicating more heterogeneous mineralization due to osteomalacia was also evident. This is the first report on changes of bone histomorphometry and bone matrix mineralization in iron-induced osteomalacia. © 2017 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Johann Bartko
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept., Hanusch Hospital, Vienna, Austria
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept., Hanusch Hospital, Vienna, Austria
| | - Shahin Zandieh
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept., Hanusch Hospital, Vienna, Austria.,Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Vienna, Austria
| | - Attila Brehm
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept., Hanusch Hospital, Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept., Hanusch Hospital, Vienna, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept., Hanusch Hospital, Vienna, Austria
| |
Collapse
|
22
|
Kim KM, Lee SY, Rhee Y. Influence of Dosing Interval and Administration on the Bone Metabolism, Skeletal Effects, and Clinical Efficacy of Parathyroid Hormone in Treating Osteoporosis: A Narrative Review. JBMR Plus 2017; 1:36-45. [PMID: 30283879 PMCID: PMC6124169 DOI: 10.1002/jbm4.10005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/09/2017] [Indexed: 01/05/2023] Open
Abstract
Recombinant human parathyroid hormone (PTH) is the key anabolic agent used for preventing fracture in postmenopausal women with osteoporosis. In bone metabolism, PTH signaling is mediated through a G protein–coupled receptor that affects various post‐receptor signaling pathways. Results of preclinical and clinical studies have shown that PTH improves both the structure and strength of bone tissue. Once daily subcutaneous injection of the PTH fragment, teriparatide (PTH [1‐34]), is the most commonly recommended formulation and dosing strategy in clinical practice. However, other dosing intervals, formulations, and routes have been investigated in preclinical and clinical studies. In particular, once‐weekly and cyclical administration have been investigated mainly as a means of reducing the high direct costs of treatment. In preclinical studies, bone formation/resorption markers, bone mineral density measurements, and histomorphometric parameters improved with both once‐daily and once‐weekly administration. However, the magnitude and duration of such improvements were generally greater with once‐daily PTH administration. In clinical studies, reductions in fracture incidence were also noted with both once‐daily and once‐weekly PTH administration, although improvements in nonvertebral fractures are less evident with once‐weekly administration. This narrative review details the differences between PTH formulation and dosing strategies in relation to preclinical and clinical efficacy/safety parameters, although it should be stressed that no head‐to‐head studies allow direct comparisons. This review also seeks to outline practical considerations involved with PTH prescribing and new directions in research regarding routes of administration. © 2017 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Kyoung Min Kim
- Division of Endocrinology and Metabolism Department of Internal Medicine Seoul National University Bundang Hospital and Seoul National University College of Medicine Seongnam Republic of Korea
| | | | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute Severance Hospital, Yonsei University College of Medicine Seoul Republic of Korea
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW The term renal osteodystrophy has been used to describe a wide variety of bone problems facing patients with chronic kidney disease (CKD). Here, we review the history of the use of this term. RECENT FINDINGS Bone disease resulting from CKD was first noticed in 1890. The term "renal osteodystrophy" was used to define the bone disease in 1942. Since then, important discoveries have increased our knowledge of the complexities of bone physiology in these patients. At the same time, secular changes in the disease have occurred. The terms used to describe the bone histological findings have changed as well, reflecting new understanding of the physiological processes. However, since different investigators used the terms in different ways, the need to standardize the nomenclature has become increasingly important. Ongoing international collaboration about nosography will allow more optimal communication among scientists and clinicians as we continue to make new discoveries.
Collapse
Affiliation(s)
- Susan M Ott
- University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| |
Collapse
|
24
|
Abstract
Renal osteodystrophy is a feature of chronic kidney disease (CKD), with increasing prevalence as CKD progresses. This bone disease is responsible for major morbidity, including fractures, and a deterioration in the quality of life and its sequelae. Circulating biomarkers of renal osteodystrophy typically indicate bone turnover, but not other features of bone, like bone volume, mineralization, quality or strength. Bone turnover can be considered to be primarily a reflection of bone cell activity, in particular that of osteoblasts and osteoclasts. Since current treatments for bone disease usually target cellular activity, biomarkers are considered to be able to contribute to the decision-making for treatment and its follow-up. In CKD, one has to consider the impact of a diminished clearance of biomarkers or their altered metabolism, both potentially limiting its clinical use. Here, several aspects of the most frequently used biomarkers of bone turnover are reviewed, with an emphasis on the specific situation represented by CKD. This review is based on the overview lecture at the symposium held in Amsterdam, September 23, 2016: “The Bone In CKD”, organized by the CKD-MBD working group of ERA-EDTA.
Collapse
Affiliation(s)
- Marc G Vervloet
- Department of Nephrology and Institute of Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | | |
Collapse
|
25
|
Inhibitory Effects of Dopamine Receptor D 1 Agonist on Mammary Tumor and Bone Metastasis. Sci Rep 2017; 7:45686. [PMID: 28374823 PMCID: PMC5379485 DOI: 10.1038/srep45686] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/02/2017] [Indexed: 01/01/2023] Open
Abstract
Dopaminergic signaling plays a critical role in the nervous system, but little is known about its potential role in breast cancer and bone metabolism. A screening of ~1,000 biologically active compounds revealed that a selective agonist of dopamine receptor D1 (DRD1), A77636, inhibited proliferation of 4T1.2 mammary tumor cells as well as MDA-MB-231 breast cancer cells. Herein, we examined the effect of A77636 on bone quality using a mouse model of bone metastasis from mammary tumor. A77636 inhibited migration of cancer cells in a DRD1-dependent fashion and suppressed development of bone-resorbing osteoclasts by downregulating NFATc1 through the elevation of phosphorylation of eIF2α. In the mouse model of bone metastasis, A77636 reduced osteolytic lesions and prevented mechanical weakening of the femur and tibia. Collectively, we expect that dopaminergic signaling might provide a novel therapeutic target for breast cancer and bone metastasis.
Collapse
|
26
|
Ramcharan MA, Faillace ME, Guengerich Z, Williams VA, Jepsen KJ. The development of inter-strain variation in cortical and trabecular traits during growth of the mouse lumbar vertebral body. Osteoporos Int 2017; 28:1133-1143. [PMID: 27734101 PMCID: PMC5890929 DOI: 10.1007/s00198-016-3801-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/29/2016] [Indexed: 12/21/2022]
Abstract
How cortical and trabecular bone co-develop to establish a mechanically functional structure is not well understood. Comparing early postnatal differences in morphology of lumbar vertebral bodies for three inbred mouse strains identified coordinated changes within and between cortical and trabecular traits. These early coordinate changes defined the phenotypic differences among the inbred mouse strains. INTRODUCTION Age-related changes in cortical and trabecular traits have been well studied; however, very little is known about how these bone tissues co-develop from day 1 of postnatal growth to establish functional structures by adulthood. In this study, we aimed to establish how cortical and trabecular tissues within the lumbar vertebral body change during growth for three inbred mouse strains that express wide variation in adult bone structure and function. METHODS Bone traits were quantified for lumbar vertebral bodies of female A/J, C57BL/6J (B6), and C3H/HeJ (C3H) inbred mouse strains from 1 to 105 days of age (n = 6-10 mice/age/strain). RESULTS Inter-strain differences in external bone size were observed as early as 1 day of age. Reciprocal and rapid changes in the trabecular bone volume fraction and alignment in the direction of axial compression were observed by 7 days of age. Importantly, the inter-strain difference in adult trabecular bone volume fraction was established by 7 days of age. Early variation in external bone size and trabecular architecture was followed by progressive increases in cortical area between 28 and 105 days of age, with the greatest increases in cortical area seen in the mouse strain with the lowest trabecular mass. CONCLUSION Establishing the temporal changes in bone morphology for three inbred mouse strains revealed that genetic variation in adult trabecular traits were established early in postnatal development. Early variation in trabecular architecture preceded strain-specific increases in cortical area and changes in cortical thickness. This study established the sequence of how cortical and trabecular traits co-develop during growth, which is important for identifying critical early ages to further focus on intervention studies that optimize adult bone strength.
Collapse
Affiliation(s)
- M A Ramcharan
- Department of Biomedical Engineering, The City College of New York c/o CUNY Graduate Center, New York, NY, USA
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Orthopaedic Surgery, University of Michigan, 109 Zina Pitcher Place, Room 2001, Ann Arbor, MI, 48109-2200, USA
| | - M E Faillace
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Z Guengerich
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - V A Williams
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, 109 Zina Pitcher Place, Room 2001, Ann Arbor, MI, 48109-2200, USA.
| |
Collapse
|
27
|
Zelenchuk LV, Hedge AM, Rowe PSN. Age dependent regulation of bone-mass and renal function by the MEPE ASARM-motif. Bone 2015; 79:131-42. [PMID: 26051469 PMCID: PMC4501877 DOI: 10.1016/j.bone.2015.05.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/07/2015] [Accepted: 05/22/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT Mice with null mutations in matrix extracellular phosphoglycoprotein (MEPE) have increased bone mass, increased trabecular density and abnormal cancellous bone (MN-mice). These defects worsen with age and MEPE overexpression induces opposite effects. Also, genome wide association studies show that MEPE plays a major role in bone mass. We hypothesized that the conserved C-terminal MEPE ASARM-motif is chiefly responsible for regulating bone mass and trabecular structure. DESIGN To test our theory we overexpressed C-terminal ASARM-peptide in MN-mice using the Col1α1 promoter (MNAt-mice). We then compared the bone and renal phenotypes of the MNAt-mouse with the MN-mouse and the X-linked hypophosphatemic rickets mouse (HYP). The HYP mouse overexpresses ASARM-peptides and is defective for the PHEX gene. RESULTS The MN-mouse developed increased bone mass, bone strength and trabecular abnormalities that worsened markedly with age. Defects in bone formation were chiefly responsible with suppressed sclerostin and increased active β-catenin. Increased uric acid levels also suggested that abnormalities in purine-metabolism and a reduced fractional excretion of uric acid signaled additional renal transport changes. The MN mouse developed a worsening hyperphosphatemia and reduced FGF23 with age. An increase in the fractional excretion of phosphate (FEP) despite the hyperphosphatemia confirms an imbalance in kidney-intestinal phosphate regulation. Also, the MN mice showed an increased creatinine clearance suggesting hyperfiltration. A reversal of the MN bone-renal phenotype changes occurred with the MNAt mice including the apparent hyperfiltration. The MNAt mice also developed localized hypomineralization, hypophosphatemia and increased FGF23. CONCLUSIONS The C-terminal ASARM-motif plays a major role in regulating bone-mass and cancellous structure as mice age. In healthy mice, the processing and release of free ASARM-peptide are chiefly responsible for preserving normal bone and renal function. Free ASARM-peptide also affects renal mineral phosphate handling by influencing FGF23 expression. These findings have implications for understanding age-dependent osteoporosis, unraveling drug-targets and developing treatments.
Collapse
Affiliation(s)
- Lesya V Zelenchuk
- The Kidney Institute, Kansas University Medical Center, Kansas City, KS, USA
| | - Anne-Marie Hedge
- The Kidney Institute, Kansas University Medical Center, Kansas City, KS, USA
| | - Peter S N Rowe
- The Kidney Institute, Kansas University Medical Center, Kansas City, KS, USA.
| |
Collapse
|
28
|
Bover J, Ureña P, Brandenburg V, Goldsmith D, Ruiz C, DaSilva I, Bosch RJ. Adynamic bone disease: from bone to vessels in chronic kidney disease. Semin Nephrol 2015; 34:626-40. [PMID: 25498381 DOI: 10.1016/j.semnephrol.2014.09.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adynamic bone disease (ABD) is a well-recognized clinical entity in the complex chronic kidney disease (CKD)-mineral and bone disorder. Although the combination of low intact parathyroid hormone (PTH) and low bone alkaline phosphatase levels may be suggestive of ABD, the gold standard for precise diagnosis is histomorphometric analysis of tetracycline double-labeled bone biopsies. ABD essentially is characterized by low bone turnover, low bone volume, normal mineralization, and markedly decreased cellularity with minimal or no fibrosis. ABD is increasing in prevalence relative to other forms of renal osteodystrophy, and is becoming the most frequent type of bone lesion in some series. ABD develops in situations with reduced osteoanabolic stimulation caused by oversuppression of PTH, multifactorial skeletal resistance to PTH actions in uremia, and/or dysregulation of Wnt signaling. All may contribute not only to bone disease but also to the early vascular calcification processes observed in CKD. Various risk factors have been linked to ABD, including calcium loading, ageing, diabetes, hypogonadism, parathyroidectomy, peritoneal dialysis, and antiresorptive therapies, among others. The relationship between low PTH level, ABD, increased risk fracture, and vascular calcifications may at least partially explain the association of ABD with increased mortality rates. To achieve optimal bone and cardiovascular health, attention should be focused not only on classic control of secondary hyperparathyroidism but also on prevention of ABD, especially in the steadily growing proportions of diabetic, white, and elderly patients. Overcoming the insufficient osteoanabolic stimulation in ABD is the ultimate treatment goal.
Collapse
Affiliation(s)
- Jordi Bover
- Fundació Puigvert, Department of Nephrology, IIB Sant Pau, RedinRen, Barcelona, Catalonia, Spain.
| | - Pablo Ureña
- Department of Nephrology and Dialysis, Clinique du Landy, Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - Vincent Brandenburg
- Department of Cardiology and Intensive Care Medicine, Rheinisch-Westfälische Technische Hochschule (RWTH) University Hospital, Aachen, Germany
| | - David Goldsmith
- King's Health Partners Academic Health Sciences Centre (AHSC), London, United Kingdom
| | - César Ruiz
- Fundació Puigvert, Department of Nephrology, IIB Sant Pau, RedinRen, Barcelona, Catalonia, Spain
| | - Iara DaSilva
- Fundació Puigvert, Department of Nephrology, IIB Sant Pau, RedinRen, Barcelona, Catalonia, Spain
| | - Ricardo J Bosch
- Fundació Puigvert, Department of Nephrology, IIB Sant Pau, RedinRen, Barcelona, Catalonia, Spain
| |
Collapse
|
29
|
Liao HW, Hung PH, Hsiao CY, Liou HH, Lin HS, Huang TH, Jou IM, Tsai KJ. Relationship between Fibroblast Growth Factor 23 and Biochemical and Bone Histomorphometric Alterations in a Chronic Kidney Disease Rat Model Undergoing Parathyroidectomy. PLoS One 2015; 10:e0133278. [PMID: 26186634 PMCID: PMC4506049 DOI: 10.1371/journal.pone.0133278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/23/2015] [Indexed: 12/15/2022] Open
Abstract
Background Phosphate burden in chronic kidney disease (CKD) leads to elevated serum fibroblast factor-23 (FGF-23) levels, secondary hyperparathyroidism and chronic kidney disease-mineral bone disorder (CKD-MBD). However dissociated hyperphosphatemia and low serum FGF-23 concentrations have been observed in experimentally parathyoridectomized rats. The relationships between serum mineral, hormone, and bone metabolism may be altered in the presence of CKD. The aim of our study was to investigate whether a consistent relationship existed between serum FGF-23 levels, specific serum biochemical markers, and histomorphometric parameters of bone metabolism in a parathyroidectomized CKD animal model. Results Sprague Dawley rats were divided into 3 groups: parathyroidectomy (PTX) and CKD (PTX+CKD, 9 rats), CKD without PTX (CKD, 9 rats), and neither PTX nor CKD (sham-operated control, 8 rats); CKD was induced by partial nephrectomy. At 8 weeks after partial nephrectomy, serum biomarkers were measured. Bone histomorphometries of the distal femoral metaphyseal bone were analyzed. The mean serum FGF-23 levels and mean bone formation rate were the highest in the CKD group and the lowest in the PTX+CKD group. Bone volume parameters increased significantly in the PTX+CKD group. Pearson’s correlation revealed that serum FGF-23 levels associated with those of intact parathyroid hormone, phosphate, collagen type I C-telopeptide, and calcium. Univariate linear regression showed that serum FGF-23 values correlated with bone formation rate, bone volume, and osteoid parameters. Stepwise multivariate regression analysis revealed that circulating FGF-23 values were independently associated with bone volume and thickness (β = -0.737; p < 0.001 and β = -0.526; p = 0.006, respectively). Serum parathyroid hormone levels independently correlated with bone formation rate (β = 0.714; p < 0.001) while collagen type I C-telopeptide levels correlated with osteoid parameter. Conclusion Serum FGF-23 levels independently correlated with bone volume parameters in rats with experimentally induced CKD.
Collapse
Affiliation(s)
| | - Peir-Haur Hung
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-yi Christian Hospital, Chiayi City, Taiwan
- Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chih-Yen Hsiao
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-yi Christian Hospital, Chiayi City, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Hsin-Shih Lin
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan, Taiwan
| | - Tsang-Hai Huang
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
| |
Collapse
|
30
|
Zelenchuk LV, Hedge AM, Rowe PSN. SPR4-peptide alters bone metabolism of normal and HYP mice. Bone 2015; 72:23-33. [PMID: 25460577 PMCID: PMC4342984 DOI: 10.1016/j.bone.2014.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/06/2014] [Accepted: 11/14/2014] [Indexed: 11/13/2022]
Abstract
CONTEXT ASARM-peptides are substrates and ligands for PHEX, the gene responsible for X-linked hypophosphatemic rickets (HYP). PHEX binds to the DMP1-ASARM-motif to form a trimeric-complex with α5β3-integrin on the osteocyte surface and this suppresses FGF23 expression. ASARM-peptide disruption of this complex increases FGF23 expression. We used a 4.2kDa peptide (SPR4) that binds to ASARM-peptide and ASARM-motif to study DMP1-PHEX interactions and to assess SPR4 for treating inherited hypophosphatemic rickets. DESIGN Subcutaneously transplanted osmotic pumps were used to infuse SPR4-peptide or vehicle into wild-type mice (WT) and HYP-mice for 4 weeks. RESULTS Asymmetrically distributed mineralization defects occurred with WT-SPR4 femurs. Specifically, SPR4 induced negative effects on trabecular bone and increased bone volume and mineralization in cortical-bone. Markedly increased sclerostin and reduced active β-catenin occurred with HYP mice. SPR4-infusion suppressed sclerostin and increased active β-catenin in WT and HYP mice and improved HYP-mice trabecular mineralization defects but not cortical mineralization defects. CONCLUSIONS SPR4-peptide has bimodal activity and acts by: (1) preventing DMP1 binding to PHEX and (2) sequestering an inhibitor of DMP1-PHEX binding, ASARM-peptide. In PHEX defective HYP-mice the second pathway predominates. Although SPR4-peptide improved trabecular calcification defects, decreased sclerostin and increased active β-catenin it did not correct HYP-mice cortical mineralization defects on a normal phosphate diet. Thus, for inherited hypophosphatemic rickets patients on a normal phosphate diet, SPR4-peptide is not a useful therapeutic.
Collapse
Affiliation(s)
- Lesya V Zelenchuk
- The Kidney Institute, Kansas University Medical Center, Kansas City, KS, USA
| | - Anne-Marie Hedge
- The Kidney Institute, Kansas University Medical Center, Kansas City, KS, USA
| | - Peter S N Rowe
- The Kidney Institute, Kansas University Medical Center, Kansas City, KS, USA.
| |
Collapse
|
31
|
Abstract
End-stage renal disease is a prevalent condition that substantially impacts a patient's quality of life. As medical advancements improve function and rates of survival, the number of persons with end-stage renal disease will grow, with orthopaedic surgeons increasingly encountering patients with the disease in their practice. End-stage renal disease is a complex medical condition that is often associated with multiple medical comorbidities. Orthopaedic surgery in patients with this disease is associated with at least a twofold risk of complications and mortality compared with a population without end-stage renal disease. Patients are at an increased risk for cardiovascular, metabolic, hematologic, and infectious complications. Orthopaedic surgeons should be familiar with pertinent issues in the preoperative evaluation and the postoperative management of these patients and should understand the risks of surgery to better inform patients and family. Careful coordination with consulting specialists is necessary to minimize morbidity and improve outcome.
Collapse
|
32
|
Nooh N, Abdullah WA, El-Awady Grawish M, Ramalingam S, Hassan G, Javed F, Al-Hezaimi K. Evaluation of bone regenerative capacity following distraction osteogenesis of goat mandibles using two different bone cutting techniques. J Craniomaxillofac Surg 2014; 42:255-61. [PMID: 23810515 DOI: 10.1016/j.jcms.2013.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/07/2013] [Accepted: 05/07/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nasser Nooh
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, PO Box 60169, Riyadh 11545, Saudi Arabia; Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, 3D Imaging and Biomechanical Lab, College of Biomedical Applied Science, King Saud University, Saudi Arabia.
| | - Walid A Abdullah
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, PO Box 60169, Riyadh 11545, Saudi Arabia; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Mohammed El-Awady Grawish
- Oral Medicine and Diagnostic Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Sundar Ramalingam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, PO Box 60169, Riyadh 11545, Saudi Arabia
| | - Ghada Hassan
- Oral Biology, Dental Health Department, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Fawad Javed
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, 3D Imaging and Biomechanical Lab, College of Biomedical Applied Science, King Saud University, Saudi Arabia
| | - Khalid Al-Hezaimi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, 3D Imaging and Biomechanical Lab, College of Biomedical Applied Science, King Saud University, Saudi Arabia
| |
Collapse
|
33
|
Cozzolino M, Ketteler M, Martin KJ, Sharma A, Goldsmith D, Khan S. Paricalcitol- or cinacalcet-centred therapy affects markers of bone mineral disease in patients with secondary hyperparathyroidism receiving haemodialysis: results of the IMPACT-SHPT study. Nephrol Dial Transplant 2014; 29:899-905. [PMID: 24500308 DOI: 10.1093/ndt/gfu011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this Phase 4 international study, efficacy and safety of paricalcitol-centred therapy were compared with that of cinacalcet-centred therapy for the treatment of chronic kidney disease (CKD)-associated secondary hyperparathyroidism (SHPT) in patients undergoing haemodialysis (ClinicalTrials.gov identifier NCT00977080). METHODS Patients ≥ 18 years of age with Stage 5 CKD and SHPT [intact parathyroid hormone (iPTH) level of 300-800 pg/mL, calcium level of 8.4-10.0 mg/dL and phosphate concentration of ≤ 6.5 mg/dL] who were undergoing haemodialysis were included. Patients were randomized by mode of paricalcitol administration [i.e. intravenous (IV) or oral strata] to receive paricalcitol- or cinacalcet-centred therapy for ≤ 28 weeks. Changes in metabolic markers [total alkaline phosphatase (AP), bone-specific AP and fibroblast growth factor-23 (FGF-23)] and the proportion of patients in each treatment group who achieved an iPTH level of 150-300 pg/mL during Weeks 8, 16 and 21-28 as a composite value were evaluated. RESULTS Compared with cinacalcet-centred therapy, levels of both bone turnover markers were significantly reduced from baseline with IV and oral paricalcitol-centred treatment (P < 0.05 for both dosing strata) at Weeks 8, 16 and 28. Levels of FGF-23 were increased with paricalcitol versus cinacalcet-centred treatment. A greater proportion of patients receiving paricalcitol-centred therapy achieved target iPTH levels (i.e. 150-300 pg/mL) throughout the study in the IV and oral dosing strata compared with patients receiving cinacalcet-centred treatment. CONCLUSIONS In patients with CKD and SHPT undergoing haemodialysis, paricalcitol-centred therapy reduced circulating bone turnover markers and iPTH levels and increased FGF-23 levels compared with cinacalcet-centred treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00977080.
Collapse
Affiliation(s)
- Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | | | | | | | | | | |
Collapse
|
34
|
Nooh N, Abdullah WA, Grawish MEA, Ramalingam S, Javed F, Al-Hezaimi K. The effects of surgicel and bone wax hemostatic agents on bone healing: An experimental study. Indian J Orthop 2014; 48:319-25. [PMID: 24932041 PMCID: PMC4052034 DOI: 10.4103/0019-5413.129451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The biological effects of hemostatic agends on the physiological healing process need to be tested. The aim of this study was to assess the effects of oxidized cellulose (surgicel) and bone wax on bone healing in goats' feet. MATERIALS AND METHODS Three congruent circular bone defects were created on the lateral aspects of the right and left metacarpal bones of ten goats. One defect was left unfilled and acted as a control; the remaining two defects were filled with bone wax and surgicel respectively. The 10 animals were divided into two groups of 5 animals each, to be sacrificed at the 3(rd) and 5(th) week postoperatively. Histological analysis assessing quality of bone formed and micro-computed tomography (MCT) measuring the quantities of bone volume (BV) and bone density (BD) were performed. The results of MCT analysis pertaining to BV and BD were statistically analyzed using two-way analysis of variance (ANOVA) and posthoc least significant difference tests. RESULTS Histological analysis at 3 weeks showed granulation tissue with new bone formation in the control defects, active bone formation only at the borders for surgicel filled defects and fibrous encapsulation with foreign body reaction in the bone wax filled defects. At 5 weeks, the control and surgicel filled defects showed greater bone formation; however the control defects had the greatest amount of new bone. Bone wax filled defects showed very little bone formation. The two-way ANOVA for MCT results showed significant differences for BV and BD between the different hemostatic agents during the two examination periods. CONCLUSION Surgicel has superiority over bone wax in terms of osseous healing. Bone wax significantly hinders osteogenesis and induces inflammation.
Collapse
Affiliation(s)
- Nasser Nooh
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, 3D Imaging and Biomechanical Lab. College of Biomedical Applied Science, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Prof. Nasser Nooh, Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. E-mail:
| | - Walid A Abdullah
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
| | - Mohammed El-Awady Grawish
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Department of Oral Biology, Faculty of Dentistry, Mansoura University, Egypt
| | - Sundar Ramalingam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fawad Javed
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, 3D Imaging and Biomechanical Lab. College of Biomedical Applied Science, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Al-Hezaimi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, 3D Imaging and Biomechanical Lab. College of Biomedical Applied Science, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
35
|
Hong SH, Jiang X, Chen L, Josh P, Shin DG, Rowe D. Computer-Automated Static, Dynamic and Cellular Bone Histomorphometry. ACTA ACUST UNITED AC 2014; Suppl 1:004. [PMID: 25019033 PMCID: PMC4090931 DOI: 10.4172/2157-7552.s1-004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Dynamic and cellular histomorphometry of trabeculae is the most
biologically relevant way of assessing steady state bone health. Traditional
measurement involves manual visual feature identification by a trained and
qualified professional. Inherent with this methodology is the time and cost
expenditure, as well as the subjectivity that naturally arises under human
visual inspection. In this work, we propose a rapidly deployable, automated, and
objective method for dynamic histomorphometry. We demonstrate that our method is
highly effective in assessing cellular activities in distal femur and vertebra
of mice which are injected with calcein and alizarin complexone 7 and 2 days
prior to sacrifice. The mineralized bone tissues of mice are cryosectioned using
a tape transfer protocol. A sequential workflow is implemented in which
endogenous fluorescent signals (bone mineral, green and red mineralization
lines), tartrate resistant acid phosphatase identified by ELF-97 and alkaline
phosphatase identified by Fast Red are captured as individual tiled images of
the section for each fluorescent color. All the images are then submitted to an
image analysis pipeline that automates identification of the mineralized regions
of bone and selection of a region of interest. The TRAP and AP stained images
are aligned to the mineralized image using strategically placed fluorescent
registration beads. Fluorescent signals are identified and are related to the
trabecular surface within the ROI. Subsequently, the pipelined method computes
static measurements, dynamic measurements, and cellular activities of osteoclast
and osteoblast related to the trabecular surface. Our method has been applied to
the distal femurs and vertebrae of 8 and 16 week old male and female C57Bl/6J
mice. The histomorphometric results reveal a significantly greater bone turnover
rate in female in contrast to male irrespective of age, validating similar
outcomes reported by other studies.
Collapse
Affiliation(s)
- Seung-Hyun Hong
- Department of Computer Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Xi Jiang
- Department of Reconstructive Sciences, Biomaterials and Skeletal Development School of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Li Chen
- Department of Reconstructive Sciences, Biomaterials and Skeletal Development School of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Pujan Josh
- Department of Computer Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Dong-Guk Shin
- Department of Computer Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - David Rowe
- Department of Reconstructive Sciences, Biomaterials and Skeletal Development School of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut
| |
Collapse
|
36
|
Govindarajan P, Böcker W, El Khassawna T, Kampschulte M, Schlewitz G, Huerter B, Sommer U, Dürselen L, Ignatius A, Bauer N, Szalay G, Wenisch S, Lips KS, Schnettler R, Langheinrich A, Heiss C. Bone matrix, cellularity, and structural changes in a rat model with high-turnover osteoporosis induced by combined ovariectomy and a multiple-deficient diet. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 184:765-77. [PMID: 24384131 DOI: 10.1016/j.ajpath.2013.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/08/2013] [Accepted: 11/12/2013] [Indexed: 12/29/2022]
Abstract
In estrogen-deficient, postmenopausal women, vitamin D and calcium deficiency increase osteoporotic fracture risk. Therefore, a new rat model of combined ovariectomy and multiple-deficient diet was established to mimic human postmenopausal osteoporotic conditions under nutrient deficiency. Sprague-Dawley rats were untreated (control), laparatomized (sham), or ovariectomized and received a deficient diet (OVX-Diet). Multiple analyses involving structure (micro-computed tomography and biomechanics), cellularity (osteoblasts and osteoclasts), bone matrix (mRNA expression and IHC), and mineralization were investigated for a detailed characterization of osteoporosis. The study involved long-term observation up to 14 months (M14) after laparotomy or after OVX-Diet, with intermediate time points at M3 and M12. OVX-Diet rats showed enhanced osteoblastogenesis and osteoclastogenesis. Bone matrix markers (biglycan, COL1A1, tenascin C, and fibronectin) and low-density lipoprotein-5 (bone mass marker) were down-regulated at M12 in OVX-Diet rats. However, up-regulation of matrix markers and existence of unmineralized osteoid were seen at M3 and M14. Osteoclast markers (matrix metallopeptidase 9 and cathepsin K) were up-regulated at M14. Micro-computed tomography and biomechanics confirmed bone fragility of OVX-Diet rats, and quantitative RT-PCR revealed a higher turnover rate in the humerus than in lumbar vertebrae, suggesting enhanced bone formation and resorption in OVX-Diet rats. Such bone remodeling caused disturbed bone mineralization and severe bone loss, as reported in patients with high-turnover, postmenopausal osteoporosis. Therefore, this rat model may serve as a suitable tool to evaluate osteoporotic drugs and new biomaterials or fracture implants.
Collapse
Affiliation(s)
| | - Wolfgang Böcker
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany; Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Thaqif El Khassawna
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
| | - Marian Kampschulte
- Department of Radiology, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Gudrun Schlewitz
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Britta Huerter
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
| | - Ursula Sommer
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, the Centre of Musculoskeletal Research, University of Ulm, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, the Centre of Musculoskeletal Research, University of Ulm, Ulm, Germany
| | - Natali Bauer
- Department of Veterinary Clinical Sciences, Clinical Pathology, and Clinical Pathophysiology, Justus-Liebig University, Giessen, Germany
| | - Gabor Szalay
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany; Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Sabine Wenisch
- Institute of Veterinary-Anatomy, Justus-Liebig University, Giessen, Germany
| | - Katrin S Lips
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
| | - Reinhard Schnettler
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany; Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | | | - Christian Heiss
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany; Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany.
| |
Collapse
|
37
|
Abstract
Abnormalities in bone turnover, mineralization, and volume represent one of the three components of chronic kidney disease–related mineral and bone disorder (CKD-MBD). The risk of hip fracture is considerably high, while the risk of spinal compression fracture may not be more elevated among CKD patients than in general population. The relationship between bone fracture and bone mineral density in CKD patients is more complex than in those without kidney disease. An increase in the rate of falls has been reported to be a major cause of high hip fracture risk among CKD patients; however, it certainly is not the only underlying mechanism. Abnormal parathyroid function is not likely to be a major cause of hip fracture among CKD patients. In experimental CKD animals, mechanical elasticity properties of long bones showed an inverse correlation with kidney function. The deterioration of bone elasticity showed a significant correlation with bone biochemical changes. Of note, administration of the oral absorbent AST-120 was capable of preventing both changes. These findings suggest that uremic toxins cause a deterioration of bone material properties, and changes in material properties disturb bone elasticity. This disease concept cannot be considered to be a direct consequence of CKD-MBD. We therefore would like to call it ‘uremic osteoporosis'. This entity may be a major cause of increased hip fracture risk among CKD patients.
Collapse
|
38
|
Tantikanlayaporn D, Wichit P, Weerachayaphorn J, Chairoungdua A, Chuncharunee A, Suksamrarn A, Piyachaturawat P. Bone sparing effect of a novel phytoestrogen diarylheptanoid from Curcuma comosa Roxb. in ovariectomized rats. PLoS One 2013; 8:e78739. [PMID: 24244350 PMCID: PMC3823985 DOI: 10.1371/journal.pone.0078739] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/16/2013] [Indexed: 01/06/2023] Open
Abstract
Phytoestrogens have been implicated in the prevention of bone loss in postmenopausal osteoporosis. Recently, an active phytoestrogen from Curcuma comosa Roxb, diarylheptanoid (DPHD), (3R)-1,7-diphenyl-(4E,6E)-4,6-heptadien-3-ol, was found to strongly promote human osteoblast function in vitro. In the present study, we demonstrated the protective effect of DPHD on ovariectomy-induced bone loss (OVX) in adult female Sprague-Dawley rats with 17β-estradiol (E2, 10 µg/kg Bw) as a positive control. Treatment of OVX animals with DPHD at 25, 50, and 100 mg/kg Bw for 12 weeks markedly increased bone mineral density (BMD) of tibial metaphysis as measured by peripheral Quantitative Computed Tomography (pQCT). Histomorphometric analysis of bone structure indicated that DPHD treatment retarded the ovariectomy-induced deterioration of bone microstructure. Ovariectomy resulted in a marked decrease in trabecular bone volume, number and thickness and these changes were inhibited by DPHD treatment, similar to that seen with E2. Moreover, DPHD decreased markers of bone turnover, including osteocalcin and tartrate resistant acid phosphatase (TRAP) activity. These results suggest that DPHD has a bone sparing effect in ovariectomy-induced trabecular bone loss and prevents deterioration of bone microarchitecture by suppressing the rate of bone turnover. Therefore, DPHD appears to be a promising candidate for preserving bone mass and structure in the estrogen deficient women with a potential role in reducing postmenopausal osteoporosis.
Collapse
Affiliation(s)
| | - Patsorn Wichit
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Arthit Chairoungdua
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Aporn Chuncharunee
- Department of Anatomy, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apichart Suksamrarn
- Department of Chemistry, Faculty of Science, Ramkhamhaeng University, Bangkok, Thailand
| | - Pawinee Piyachaturawat
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
- * E-mail:
| |
Collapse
|
39
|
Frost ML, Compston JE, Goldsmith D, Moore AE, Blake GM, Siddique M, Skingle L, Fogelman I. (18)F-fluoride positron emission tomography measurements of regional bone formation in hemodialysis patients with suspected adynamic bone disease. Calcif Tissue Int 2013; 93:436-47. [PMID: 23995764 PMCID: PMC3824308 DOI: 10.1007/s00223-013-9778-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/25/2013] [Indexed: 01/10/2023]
Abstract
(18)F-fluoride positron emission tomography ((18)F-PET) allows the assessment of regional bone formation and could have a role in the diagnosis of adynamic bone disease (ABD) in patients with chronic kidney disease (CKD). The purpose of this study was to examine bone formation at multiple sites of the skeleton in hemodialysis patients (CKD5D) and assess the correlation with bone biopsy. Seven CKD5D patients with suspected ABD and 12 osteoporotic postmenopausal women underwent an (18)F-PET scan, and bone plasma clearance, K i, was measured at ten skeletal regions of interest (ROI). Fifteen subjects had a transiliac bone biopsy following double tetracycline labeling. Two CKD5D patients had ABD confirmed by biopsy. There was significant heterogeneity in K i between skeletal sites, ranging from 0.008 at the forearm to 0.028 mL/min/mL at the spine in the CKD5D group. There were no significant differences in K i between the two study groups or between the two subjects with ABD and the other CKD5D subjects at any skeletal ROI. Five biopsies from the CKD5D patients had single tetracycline labels only, including the two with ABD. Using an imputed value of 0.3 μm/day for mineral apposition rate (MAR) for biopsies with single labels, no significant correlations were observed between lumbar spine K i corrected for BMAD (K i/BMAD) and bone formation rate (BFR/BS), or MAR. When biopsies with single labels were excluded, a significant correlation was observed between K i/BMAD and MAR (r = 0.81, p = 0.008) but not BFR/BS. Further studies are required to establish the sensitivity of (18)F-PET as a diagnostic tool for identifying CKD patients with ABD.
Collapse
Affiliation(s)
- Michelle L Frost
- Osteoporosis Unit, Division of Imaging Sciences and Biomedical Engineering, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK,
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Wang Y, Lin B. In silico investigations of potential anabolic treatments in multiple myeloma-induced bone disease. Bone 2013; 55:132-49. [PMID: 23416846 DOI: 10.1016/j.bone.2013.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/17/2012] [Accepted: 02/06/2013] [Indexed: 01/02/2023]
Abstract
No anabolic drugs are currently approved to treat multiple myeloma (MM)-induced bone disease and the anti-MM agent bortezomib exhibits the anabolic effects in the clinic. In this study, we focus on investigating potential anabolic treatments of MM-induced bone disease using our previously proposed MM-bone model, with the goal for clarifying the underlying molecular/cellular mechanisms. Firstly, a variety of virtual drug treatments are explored by the parametric study to clarify the anabolic-related molecular/cellular mechanisms. The real drug (i.e., bortezomib) treatments are further examined by developing an integrated model with bortezomib to validate the clarified anabolic-related molecular/cellular mechanisms. The simulated responses to the bortezomib treatments that are validated by the clinical data are consistent with the simulated responses to the virtual drug treatments. Our study clarifies that the anabolic effects in the treatment of MM-induced bone disease are associated with promoting the differentiation of bone marrow stromal cells (BMSC) and inhibiting the apoptosis of active osteoblasts, while promoting the differentiation of osteoblast precursors is instead suggested to be associated with the anti-catabolic effects. Compared with the individual anabolic therapies, the anabolic therapies that promote the differentiation of BMSC in combination with the anti-MM/anti-catabolic therapies are found to induce a greater increase in the bone volume, while the anabolic therapies that inhibit the apoptosis of active osteoblasts in combination with the anti-MM/anti-catabolic therapies induce a lower increase in the bone volume. The simulations also suggest that the direct inhibition of bortezomib on the osteoclast activity is probably a redundant mechanism.
Collapse
Affiliation(s)
- Yan Wang
- Department of Infrastructure Engineering, School of Engineering, University of Melbourne, Melbourne, VIC 3010, Australia.
| | | |
Collapse
|
41
|
Fukagawa M, Yokoyama K, Koiwa F, Taniguchi M, Shoji T, Kazama JJ, Komaba H, Ando R, Kakuta T, Fujii H, Nakayama M, Shibagaki Y, Fukumoto S, Fujii N, Hattori M, Ashida A, Iseki K, Shigematsu T, Tsukamoto Y, Tsubakihara Y, Tomo T, Hirakata H, Akizawa T. Clinical Practice Guideline for the Management of Chronic Kidney Disease-Mineral and Bone Disorder. Ther Apher Dial 2013; 17:247-88. [DOI: 10.1111/1744-9987.12058] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Mirfakhraee S, Sakhaee K, Zerwekh J, Adams-Huet B, Gruntmanis U. Risk factors for diminished bone mineral density among male hemodialysis patients--a cross-sectional study. Arch Osteoporos 2012; 7:283-90. [PMID: 23152064 DOI: 10.1007/s11657-012-0110-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/26/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED This cross-sectional study was performed to characterize the factors affecting bone mass in male hemodialysis subjects. We found that of all the factors analyzed, the strongest correlation was with body mass index. In fact, after adjusting for body weight, the correlations with bone turnover markers and sex hormones were no longer significant. PURPOSE Abnormalities in bone and mineral metabolism are commonly seen in patients with end-stage renal disease, reducing bone quality and raising the risk of fracture. This cross-sectional study was performed to characterize risk factors affecting bone mass among male hemodialysis subjects. METHODS For this cross-sectional study, we recruited 66 men from three local hemodialysis units. Subjects received dual emission X-ray absorptiometry assessment of three sites (lumbar spine, hip, and distal radius) and the values were correlated with the levels of sex hormones, non-renally excreted bone turnover markers, and mineral metabolism markers. RESULTS Subjects were found to have bone mineral density (BMD) reduced predominantly at the distal radius, with Z score < −2 seen in 15.4 % and T score < −2.5 in 21 % of men. Independent predictors of bone density included levels of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b, which were inversely correlated with the femoral neck Z score. Factors positively associated with an increased Z score included body mass index at all sites and free estradiol levels at the hip and distal radius. Markers of mineral metabolism (e.g., calcium, phosphate, and 25-hydroxyvitamin D) were not correlated with Z scores of any site or with bone turnover markers. After adjusting for body weight, the associations between BMD, sex hormones, and bone turnover markers were no longer significant. CONCLUSION We recommend that future studies seeking to assess the factors affecting bone strength among male hemodialysis subjects incorporate a weight-adjusted analysis. Additionally, dialysis-dependent men receiving dual emission X-ray absorptiometry should have the distal radius site added to the standard assessment.
Collapse
Affiliation(s)
- Sasan Mirfakhraee
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard Y5.322, Dallas, TX 75390-8857, USA
| | | | | | | | | |
Collapse
|
43
|
The Japanese Society for Dialysis Therapy. Clinical Practice Guideline for CKD-MBD. ACTA ACUST UNITED AC 2012. [DOI: 10.4009/jsdt.45.301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
44
|
|
45
|
Kazama JJ. Bone Histology in Chronic Kidney Disease-related Mineral and Bone Disorder. Ther Apher Dial 2011; 15 Suppl 1:23-5. [DOI: 10.1111/j.1744-9987.2011.00923.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
46
|
Kazama JJ, Koda R, Yamamoto S, Narita I, Gejyo F, Tokumoto A. Cancellous bone volume is an indicator for trabecular bone connectivity in dialysis patients. Clin J Am Soc Nephrol 2010; 5:292-8. [PMID: 20093344 DOI: 10.2215/cjn.04150609] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES A new assessment system for bone histology, termed the turnover-mineralization-volume system, is advocated for patients with chronic kidney disease-related mineral and bone disorder. The system measures cancellous bone volume (BV/TV) as a third major evaluation axis; however, the physiologic significance of BV/TV remains unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Conventional bone histomorphometry was performed in 75 iliac bone samples obtained from dialysis patients. In 47 of the 75 samples, the remaining samples were subjected to direct microfocus x-ray computed tomographic observation. Quantitative morphologic examinations, including micro-bone mineral densitometry, and marrow space star volume, Euler number, and node-strut analyses, were performed in the virtual three-dimensional space reconstructed from the microfocus x-ray computed tomographic images. RESULTS The levels of BV/TV were comparable in each of the conventional bone histomorphometric criteria. No significant correlations were found between BV/TV and other parameters. Two- and three-dimensional BV/TVs were significantly correlated with cancellous bone mass but not with cortical bone thickness or cortical bone mass. Two- and three-dimensional BV/TVs were significantly correlated with trabecular bone connectivity as determined by marrow space star volume, Euler number, and node-strut analyses. CONCLUSIONS In dialysis patients, BV/TV is not dependent on bone turnover or bone mineralization. BV/TV is unlikely to indicate the balance between bone formation and bone resorption. Instead, it reflects trabecular bone connectivity, and improved trabecular bone connectivity is physiologically beneficial in terms of bone quality. The turnover-mineralization-volume system offers an advantage over the conventional system for the assessment of bone quality.
Collapse
Affiliation(s)
- Junichiro James Kazama
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan.
| | | | | | | | | | | |
Collapse
|
47
|
Ambrus C, Marton A, Nemeth ZK, Mucsi I. Bone mineral density in patients on maintenance dialysis. Int Urol Nephrol 2009; 42:723-39. [DOI: 10.1007/s11255-009-9666-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 10/13/2009] [Indexed: 01/09/2023]
|
48
|
Jorgetti V. Review article: Bone biopsy in chronic kidney disease: patient level end-point or just another test? Nephrology (Carlton) 2009; 14:404-7. [PMID: 19563382 DOI: 10.1111/j.1440-1797.2009.01148.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The reduction of renal function in chronic kidney disease leads to disturbed calcium and phosphorus metabolism, impaired action of calcitriol, increased parathyroid hormone, FGF-23 levels and ultimately bone disorders. These disturbances have been traditionally termed renal osteodystrophy, which evaluation and diagnosis require a bone biopsy. In the last four decades, researchers from different countries have developed new techniques and have introduced concepts that allowed the development of bone histomorphometry, considered the key tool to study bone metabolism, remodelling and structure. In this review we focus on the relevance of bone biopsy and its respective histomorphometric analysis to help nephrologists to evaluate patients with chronic kidney disease.
Collapse
Affiliation(s)
- Vanda Jorgetti
- Nephrology Division, Hospital das Clínicas, Faculdade de Medicina, São Paulo University, São Paulo, Brazil.
| |
Collapse
|